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Evaluation of the International Study Group of Pancreatic Surgery definition of delayed gastric emptying after pancreatoduodenectomy in a high-volume centre
Abstract
Background: Delayed gastric emptying (DGE) is a common complication after pancreatoduodenectomy. The International Study Group of Pancreatic Surgery (ISGPS) definition of DGE has not been evaluated and validated in a high-volume centre. Methods: Complete data sets including assessment of gastric emptying were identified from a database of patients undergoing pancreatoduodenectomy between 2001 and 2008. Factors associated with DGE (grades A, B and C) were assessed by univariable and multivariable analyses. Results: DGE occurred in 340 (44·5 per cent) of 764 patients. Median hospital stay was significantly prolonged in patients with DGE: 13, 21 and 40 days for grades A, B and C respectively versus 11 days for patients without DGE. DGE was associated with prolonged intensive care unit (ICU) admission (at least 2 days): 20·6, 28·6 and 61·8 per cent of those with grades A, B and C respectively versus 9·4 per cent of patients without DGE. Factors independently influencing DGE grade A were female sex, preoperative heart failure and major complications (grade III–V). Validation of the DGE definition revealed that DGE grades A and B were associated with interventional treatment in 20·1 and 44·4 per cent of patients. Conclusion: The ISGPS DGE definition is feasible and applicable in patients with an uneventful postoperative course. Major postoperative complications and ICU treatment, however, might limit its usefulness. The identified risk factors for DGE are not amenable to perioperative improvement. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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  • References (32)
  • Cited By (82)
Stephen R. Grobmyer36
Estimated H-index: 36
(Memorial Sloan Kettering Cancer Center),
Fredric M. Pieracci1
Estimated H-index: 1
(Memorial Sloan Kettering Cancer Center),
Peter J. Allen61
Estimated H-index: 61
(Memorial Sloan Kettering Cancer Center)
... more
Background Improving surgical quality of care requires accurate reporting of postoperative complications. Study design Accuracy of a prospective surgical complication grading database was assessed by performing a retrospective review of 204 pancreaticoduodenectomies (PDs) entered into the database from January 1, 2001, to December 31, 2003. This updated database was then used to characterize 30-day morbidity and mortality after PD. Results On review, 13% of patients had a complication not identi...
181 Citations Source Cite
Hartwig Riediger10
Estimated H-index: 10
(University of Freiburg),
Frank Makowiec25
Estimated H-index: 25
(University of Freiburg),
Wolfgang Schareck21
Estimated H-index: 21
(University of Rostock)
... more
Patients undergoing pylorus-preserving pancreatoduodenenectomy (PPPD) have a risk of up to 50% for developing delayed gastric emptying (DGE) in the early postoperative course. From 1994 to August 2002, a total of 204 patients underwent PPPD for pancreatic or periampullary cancer (50%), chronic pancreatitis (42%), and other indications (8%). Retrocolic end-to-side duodenojejunostomy was performed below the mesocolon. DGE was defined by the inability to tolerate a regular diet after day 10 (DGE10)...
93 Citations Source Cite
1997 in Annals of Surgery [IF: 9.20]
Charles J. Yeo123
Estimated H-index: 123
(Johns Hopkins University),
John L. Cameron25
Estimated H-index: 25
,
Taylor A. Sohn40
Estimated H-index: 40
(Johns Hopkins University)
... more
OBJECTIVE: The authors reviewed the pathology, complications, and outcomes in a consecutive group of 650 patients undergoing pancreaticoduodenectomy in the 1990s. SUMMARY BACKGROUND DATA: Pancreaticoduodenectomy has been used increasingly in recent years to resect a variety of malignant and benign diseases of the pancreas and periampullary region. METHODS: Between January 1990 and July 1996, inclusive, 650 patients underwent pancreaticoduodenal resection at The Johns Hopkins Hospital. Data were ...
1,438 Citations Source Cite
2003 in World Journal of Surgery [IF: 2.77]
A. Richter11
Estimated H-index: 11
(Heidelberg University),
Marco Niedergethmann21
Estimated H-index: 21
(Heidelberg University),
Jörg Sturm17
Estimated H-index: 17
(Heidelberg University)
... more
Le pronostic de l'adenocarcinome du pancreas des patients est generalement mauvais sauf lorsqu'on peut realiser une resection a visee curatrice en cas de maladie debutante. Base sur notre experience de 25 ans, on a analyse les resultats chez 194 patients ayant eu une resection standardisee du type Kausch-Whipple pour adenocarcinome de la tete du pancreas et les facteurs pronostiques ont ete evalues. Entre 1972 et 1998, parmi 221 patients diagnostiques porteurs d'un adenocarcinome de la tete du p...
304 Citations Source Cite
2009 in Surgery [IF: 3.57]
Joon Seong Park15
Estimated H-index: 15
(Yonsei University),
Ho Kyoung Hwang14
Estimated H-index: 14
(Yonsei University),
Jae Keun Kim8
Estimated H-index: 8
(Yonsei University)
... more
Background Delayed gastric emptying (DGE) is one of the most common complications after pancreatoduodenectomy (PD). Because an objective, universally accepted definition of DGE does not yet exist, it is impossible to compare complication rates and outcomes of new operative approaches, operative techniques, and clinical trials. The International Study Group of Pancreatic Surgery (ISGPS) has proposed a universal classification for DGE based on clinical outcomes, but this classification has not bee...
83 Citations Source Cite
1993 in Annals of Surgery [IF: 9.20]
Charles J. Yeo123
Estimated H-index: 123
(Johns Hopkins University),
M K Barry1
Estimated H-index: 1
(Johns Hopkins University),
Patricia K. Sauter33
Estimated H-index: 33
(Johns Hopkins University)
... more
OBJECTIVE: This study tested the hypothesis that erythromycin, a motilin agonist, reduces the incidence of early DGE after pancreaticoduodenectomy. SUMMARY BACKGROUND DATA: Delayed gastric emptying (DGE) is a leading cause of morbidity after pancreaticoduodenectomy, occurring in up to 40% of patients. The pathogenesis of DGE has been speculated to involve factors such as peritonitis from anastomotic leaks, ischemia to the antropyloric muscles, and gastric atony in response to resection of the du...
277 Citations Source Cite
2009 in Annals of Surgery [IF: 9.20]
Emi Akizuki7
Estimated H-index: 7
,
Yasutoshi Kimura36
Estimated H-index: 36
,
Takayuki Nobuoka15
Estimated H-index: 15
... more
Objective: A prospective consecutive study was planned to evaluate the postpancreaticoduodenectomy (PD) oral intake tolerance. The occurrence of delayed gastric emptying (DGE), as defined by the International Study Group of Pancreatic Surgery (ISGPS), and the amount of dietary intake were analyzed. The risk factors for low oral intake tolerance were additionally determined. Summary Background Data: The causation of DGE after PD is still unclear. Several possible factors have been discussed, such...
69 Citations Source Cite
2006 in Annals of Surgery [IF: 9.20]
Michelle L. DeOliveira14
Estimated H-index: 14
(Johns Hopkins University),
Jordan M. Winter33
Estimated H-index: 33
(Johns Hopkins University),
Markus Schäfer31
Estimated H-index: 31
(University of Zurich)
... more
Mortality associated with pancreaticoduodenectomy (PD) has decreased dramatically to less than 5% over the past 2 decades in high-volume centers,1–6 but persistent high morbidity rates have remained an important concern for patients, healthcare providers, and payers. While mortality is an objective and easily quantifiable outcome parameter, morbidity is only poorly defined, and this shortcoming has severely hampered conclusive comparisons among centers and within the same institution over time.7...
506 Citations Download PDF Cite
2007 in Indian Journal of Surgery [IF: 0.51]
Shailesh V. Shrikhande27
Estimated H-index: 27
(Heidelberg University),
Jörg Kleeff60
Estimated H-index: 60
(Technische Universität München),
Markus W. Büchler121
Estimated H-index: 121
(Heidelberg University)
... more
While mortality following pancreaticoduodenectomy has progressively decreased over the last decade, its morbidity, especially the development of pancreatic fistula, has remained constant over the years. However, high volume centers and individual surgeons report a major decrease in the rate of post-operative pancreatic fistulas. Technical refinements are crucial to reduce, and if possible prevent, the development of pancreatic fistula. No uniformity of opinion exists as to the method of pancreat...
7 Citations Source Cite
2007 in Annals of Surgery [IF: 9.20]
Wande B. Pratt17
Estimated H-index: 17
,
Shishir K. Maithel30
Estimated H-index: 30
,
Tsafrir Vanounou6
Estimated H-index: 6
... more
Pancreatic fistula is widely regarded as the most ominous of complications following pancreatic resection. Its clinical impact and sequelae have been previously described and shown to contribute to the development of other morbid complications and high rates of mortality.1–4 Despite refinements in operative technique and advancements in postoperative management, fistulas still occur with a frequency of 5% to 30%.5–12 Efforts to mitigate this problem have included technical considerations (modifi...
236 Citations Source Cite
  • References (32)
  • Cited By (82)
Arja Gerritsen (Academic Medical Center), Quintus Molenaar1
Estimated H-index: 1
,
A. Roos W. Wennink ... more
Delayed gastric emptying is a frequent complication after pancreatoduodenectomy and often necessitates nutritional support. Current European guidelines recommend routine enteral feeding after pancreatoduodenectomy, whereas American guidelines do not. This chapter discusses the available evidence on the optimal feeding strategy in patients after pancreatoduodenectomy. A systematic literature search yielded 22 studies with 3,920 patients. Data on five feeding routes were extracted: oral feeding (n...
Source
2015 in Chirurg [IF: 0.67]
T. Schulze1
Estimated H-index: 1
,
C.-D. Heidecke1
Estimated H-index: 1
Trotz in den letzten Jahrzehnten deutlich rucklaufiger Mortalitatszahlen bleiben grose hepatopankreatobiliare Eingriffe mit einer hohen Morbiditat behaftet. Deregulierte Funktionszustande der Darmmotilitat sowie Entzundungen und Infektionen im Bereich der operierten Organe haben daran einen betrachtlichen Anteil und tragen zu einer signifikanten Verlangerung der Krankenhausaufenthaltsdauer und zu einer deutlichen Steigerung des Ressourcenverbrauchs bei. Diese Ubersichtsarbeit zeigt anhand der Au...
2 Citations Source Cite
George Kunnackal John4
Estimated H-index: 4
(Johns Hopkins University),
Vikesh K. Singh30
Estimated H-index: 30
(Johns Hopkins University),
Pankaj J. Pasricha54
Estimated H-index: 54
(Johns Hopkins University)
... more
Background The prevalence and factors associated with delayed gastric emptying (DGE) in patients undergoing total pancreatectomy with islet auto transplantation (TP-IAT) for chronic pancreatitis are unknown.
6 Citations Source Cite
Joshua Eisenberg2
Estimated H-index: 2
(Thomas Jefferson University),
Ernest L. Rosato23
Estimated H-index: 23
(Thomas Jefferson University),
Harish Lavu16
Estimated H-index: 16
(Thomas Jefferson University)
... more
Introduction Delayed gastric emptying (DGE) is a common complication after pancreaticoduodenectomy (PD), yet it remains incompletely understood. The International Study Group of Pancreatic Surgery (ISGPS) in 2007 defined a three-tiered grading system to standardize studies of DGE.
15 Citations Source Cite
2016 in Journal of Surgical Research [IF: 2.05]
Masafumi Imamura11
Estimated H-index: 11
(Sapporo Medical University),
Yasutoshi Kimura36
Estimated H-index: 36
(Sapporo Medical University),
Tatsuya Ito10
Estimated H-index: 10
(Sapporo Medical University)
... more
Abstract Background Delayed gastric emptying (DGE) is a relatively common complication after pancreatoduodenectomy (PD). The aim of this study was to determine whether DGE is affected by antecolic or retrocolic reconstruction for gastro/duodenojejunostomy after PD. Methods A literature search was performed of the MEDLINE (PubMed), Ovid SP, ISI Web of Knowledge, EMBASE, and Cochrane databases to identify randomized controlled trials (RCTs) and clinical observational studies related to this topic ...
5 Citations Source Cite
Charing Ching-Ning Chong4
Estimated H-index: 4
(The Chinese University of Hong Kong),
Kit-Fai Lee10
Estimated H-index: 10
(The Chinese University of Hong Kong),
Philip Ching‐Tak Ip4
Estimated H-index: 4
(The Chinese University of Hong Kong)
... more
Aim Evaluation of the prevalence of delayed gastric emptying (DGE) post-operatively is thwarted by an inconsistency in DGE definition. The aim of the present study was to evaluate the incidence and underlying risk factors of DGE after pancreaticoduodenectomy (PD), employing the International Group of Pancreatic Surgery (ISGPS) consensus definition. Patients and Methods Patient demographics, operative details, clinical course and pathology of 95 consecutive patients who underwent PD at a tertiary...
Source Cite
2013 in British Journal of Surgery [IF: 5.43]
Arja Gerritsen7
Estimated H-index: 7
,
M.G. Besselink18
Estimated H-index: 18
,
D. J. Gouma47
Estimated H-index: 47
... more
Background Current European guidelines recommend routine enteral feeding after pancreato-duodenectomy (PD), whereas American guidelines do not. The aim of this study was to determine the optimal feeding route after PD. Methods A systematic search was performed in PubMed, Embase and the Cochrane Library. Included were studies on feeding routes after PD that reported length of hospital stay (primary outcome). Results Of 442 articles screened, 15 studies with 3474 patients were included. Data on fi...
52 Citations Source Cite
Mehrdad Nikfarjam24
Estimated H-index: 24
(University of Melbourne),
Nezor Houli5
Estimated H-index: 5
(University of Melbourne),
Farrukh Tufail2
Estimated H-index: 2
(University of Melbourne)
... more
Context Delayed gastric emptying is a major cause of morbidity following pancreaticoduodenectomy. Objective The impact of a Braun enteroenterostomy on delayed gastric emptying, used in reconstruction following classic pancreaticoduodenectomy, was assessed. Patients Forty-four consecutive patients undergoing non-pylorus preserving pancreaticoduodenectomy from 2009 to 2011 by a single surgeon were included in this study. Interventions The first 20 patients had a standard antecolic gastroenterostom...
17 Citations Download PDF Cite
2015 in Pancreatology [IF: 2.76]
Arja Gerritsen7
Estimated H-index: 7
(Utrecht University),
Roos Wennink3
Estimated H-index: 3
(Utrecht University),
Olivier R. Busch40
Estimated H-index: 40
... more
Abstract Background Early oral feeding is currently considered the optimal routine feeding strategy after pancreatoduodenectomy (PD). Some have suggested that patients with preoperative symptoms of gastric outlet obstruction (GOO) who undergo PD have such a high risk of developing delayed gastric emptying that these patients should rather receive routine postoperative tube feeding. The aim of this study was to determine whether clinical outcomes after PD in these patients differ between postoper...
3 Citations Source Cite
Cheguevara Afaneh12
Estimated H-index: 12
(Columbia University),
Deborah Gerszberg1
Estimated H-index: 1
,
Eoin Slattery7
Estimated H-index: 7
... more
Surgery remains the only curative treatment for pancreaticobiliary tumors. These patients typically present in a malnourished state. Various screening tools have been employed to help with preoperative risk stratification. Examples include the subjective global assessment (SGA), malnutrition universal screening tool (MUST), and nutritional risk index (NRI). Adequate studies have not been performed to determine if perioperative interventions, based on nutrition risk assessment, result in less mor...
12 Citations Source Cite

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